FSA coverage is narrower than you think, and the IRS publishes the exact list

A Flexible Spending Account (FSA) covers medical, dental, and vision expenses that you pay out of pocket — but only the ones the IRS has approved. You cannot use FSA money for insurance premiums, over-the-counter medications without a prescription, cosmetic procedures, or gym memberships. The IRS maintains Publication 502, which lists every may be able to access expense category. Your employer's FSA plan document may be even more restrictive than the IRS rules allow, so you need to check both.

The key difference from an HSA is that FSA money must be spent in the same calendar year or you lose it — there is no rollover, with rare exceptions. This means you need to estimate your actual out-of-pocket costs for the year before you contribute, because money left unspent on December 31 goes back to your employer.

Key Takeaways

  • FSA covers copays, coinsurance, deductibles, and prescription medications, but not insurance premiums or most over-the-counter items.
  • Dental and vision care are covered if you pay out of pocket, including cleanings, fillings, exams, glasses, and contact lenses.
  • Medical equipment like crutches, wheelchairs, and blood pressure monitors is covered; cosmetic procedures and gym memberships are not.
  • Money not spent by December 31 is forfeited unless your plan offers a grace period or carryover, which varies by employer.
  • Your employer's FSA plan document may exclude items the IRS otherwise permits, so you must check both sources before spending.

Medical expenses your FSA will pay for

FSA covers the cost of doctor visits, urgent care, emergency room visits, and hospital stays — specifically the portion you owe out of pocket after insurance pays its share. This includes copays (the flat fee you pay at the visit), coinsurance (your percentage of the bill after insurance), and amounts toward your deductible. If your plan has a $1,500 deductible and you have paid $800 of it, FSA money can cover the remaining $700.

Prescription medications are covered in full through your FSA. Over-the-counter medications like ibuprofen, cold medicine, or antacids are not covered unless you have a prescription from a doctor — a pharmacist recommendation does not count. If your doctor writes a prescription for an over-the-counter strength medication, then FSA will cover it.

Mental health and therapy visits are covered, including copays and coinsurance for psychiatrists, psychologists, and licensed counselors. Fertility treatments, including in vitro fertilization (IVF) and related procedures, are covered. Pregnancy tests and prenatal vitamins are also may be able to access.

Dental and vision care covered by FSA

Dental cleanings, exams, fillings, root canals, crowns, and extractions are all covered. Orthodontia (braces) is covered, including the full cost of treatment, not just copays. Dentures and dental implants are covered. The only major dental exclusion is cosmetic dentistry — whitening, veneers purely for appearance, or bonding done for cosmetic reasons will not be covered, though your employer's plan may have its own definition of what counts as cosmetic.

Vision coverage includes eye exams, glasses, contact lenses, and contact lens solution. Laser eye surgery (LASIK and PRK) is covered. Sunglasses are not covered, even if you need them for a medical condition, because they are considered general-use items. If you need specialized eyewear for a specific medical condition (like protective goggles for a workplace injury), check your plan document first.

Medical equipment and supplies FSA will reimburse

Durable medical equipment — items meant to last and be reused — is covered if prescribed by a doctor. This includes wheelchairs, crutches, canes, walkers, hearing aids, blood pressure monitors, glucose meters, and oxygen equipment. Diabetic supplies like test strips, lancets, and syringes are covered. Bandages, gauze, and other wound care supplies are covered.

Elastic bandages, knee braces, back braces, and other orthopedic supports are covered. Heating pads and ice packs are covered. Bathroom safety equipment like grab bars and shower chairs is covered if prescribed for a medical condition. Wigs are covered only if prescribed for hair loss caused by a medical condition like alopecia or chemotherapy, not for cosmetic reasons.

What FSA does not cover, even if you think it should

Insurance premiums of any kind — health, dental, vision, or long-term care — cannot be paid with FSA money. This includes premiums for your employer's plan, a spouse's plan, or a plan you buy on your own. The only exception is COBRA continuation coverage premiums, which can be paid with FSA funds.

Cosmetic procedures and products are not covered: Botox, filler, hair removal, teeth whitening for appearance only, or cosmetic surgery. Gym memberships, fitness classes, and weight loss programs are not covered, even if recommended by your doctor for a medical condition. Vitamins and supplements are not covered unless they are prescribed by a doctor for a specific medical deficiency — a general multivitamin will not may have access to.

Childcare and dependent care are handled through a separate account (a Dependent Care FSA), not a medical FSA. Maternity clothes, baby formula, diapers, and other parenting supplies are not covered. Travel to receive medical care, including flights and hotels, is not covered. Meals and lodging during a hospital stay are not covered, though the hospital bill itself is.

How to know if something is covered before you spend

Start with your employer's FSA plan document, which you should have received when you enrolled. This document lists what your specific plan covers and may exclude items the IRS otherwise permits. If you cannot find it, ask your benefits administrator or HR department for a copy.

For items not clearly listed in your plan document, check IRS Publication 502 (Medical and Dental Expenses), which is free and available on the IRS website. If the item is listed there as may be able to access, it is covered under the IRS rules — though your plan may still exclude it.

If you are still unsure, contact your FSA administrator (the company that manages the account, often listed on your FSA debit card or in your benefits portal) and ask in writing. Get a written response so you have proof if there is a dispute later. Do not rely on a verbal answer or an email from someone who cannot confirm they work for the FSA administrator.

The use-it-or-lose-it rule and what happens to unspent money

Money in your FSA must be spent by December 31 of the plan year, or it is forfeited. Some employers offer a grace period (usually 2.5 months into the next year) or allow you to carry over a small amount (typically $570 in 2024, though this limit changes yearly). Check your plan document to see if either option applies to you.

Because of this rule, you should estimate conservatively. If you are unsure whether you will spend $2,500, contribute $2,000 instead. The money you do not contribute stays in your paycheck and is taxed normally. The money you contribute but do not spend is gone.

If your life changes mid-year — you lose coverage, have a baby, or experience a significant medical event — you may be able to change your FSA contribution amount. This is called a may have access to life event. Contact your HR department immediately if this happens, because you usually have only 30 to 60 days to make changes.

Frequently Asked Questions

Can I use my FSA for my spouse's or child's medical expenses?

Yes. FSA money can be used for any family member you claim as a dependent on your tax return, including your spouse and children. You do not have to be on the same insurance plan. The expense just has to be may be able to access under the IRS rules.

Are prescription glasses and contacts covered?

Yes, both are covered in full. This includes the exam, the frames, lenses, and contact lens solution. Sunglasses are not covered unless prescribed for a specific medical condition like photophobia.

What happens if I do not spend all my FSA money by the end of the year?

The unspent money is forfeited and returned to your employer — you cannot get it back. Some plans offer a grace period (usually until mid-March) or allow a small carryover. Check your plan document or ask HR whether either applies to you.

Can I use FSA money to pay my health insurance premium?

No, not for regular premiums. The only exception is COBRA continuation coverage premiums. FSA money can be used for copays, deductibles, and coinsurance, but not the premium itself.

Is a prescription required for over-the-counter medications to be covered?

Yes. Over-the-counter medications like pain relievers, cold medicine, and antacids are covered only if a doctor writes a prescription for them. A pharmacist's recommendation does not count as a prescription.